NCDs 2020

1. BURDEN AND PREVENTION OF NONCUMMINICABALE Diseases
WORLDWIDE AND NEW ZEALAND
PRESENTED BY- MR. PANDURANG GOPALRAO CHAVAN
PROGRAM- POST GRADUATE DIPLOMA IN HEALTH SCIENCES
COURSE-GLOBAL HEALTH 2020"

2. BURDEN OF NONCOMMUNICABLE DISEASES (NCDS) WORLDWIDE AND NEW ZEALAND
SOCIOECONOMIC IMPACTS ON RISK FACTORS OF NCDS
PREVENTION STRATEGIES
GLOBAL AND NEW ZEALND TARGETS
BURDEN OF CARDIOVASCULAR DISEASES (CVDS) WORLDWIDE AND NEW ZEALAND
EMERGING RISK FACTORS OF CVDS
STRATEGIES TO CURB CVDS IN NEW ZEALDNND
SCOPE OF IMPROVEMENT

3. Noncommunicable diseases
Global: -
Causes:- Responsible:- Estimated by 2025:-
Hereditary 38 millions deaths worldwide 70% deaths globally
Ecological More than 40 Million untimely death 85% deaths in HIC
Physiological 90% cases belongs to LMIC 41 million Deaths in LMIC
Behavioural reasons Expenditure
Total 7.3 trillion, 12-16.5% on CVDs and 0.7-7.4% on other NCDs
Nearly equal to 10% global GDP
CVDs
48% Deaths
Cancers
21% Deaths
Respiratory illness
12% Deaths
Diabetes
3% Deaths

4. Noncommunicable diseases
New Zealand : -
Responsible - Expenditure:-
89% of deaths yearly 23.8% total health expenditure yearly
19% by other type of NCDs 18.9 million per individuals
7000 premature deaths aged between 30 to 70 in 2012 18.7% for CVDs and Stroke, and 14.1% for cancers
Major hurdle for health equality 7.4% for respiratory, liver and Kidney, 5.5% for diabetes
CVDs
31% Deaths
Cancers
30% Deaths
Respiratory illness
7% Deaths
Diabetes
3% Deaths

5. Risk Factors:-
Behavioural and Metabolic
 Unhealthy Diet/salt
 Physical Inactivity
 Smoking/ Tobacco
 Alcoholism
 Obesity,
 Air Pollution,
 Hypertension,
 Hyperglycaemia
 Hyperlipidaemia
7.2
4.1
3.3
1.6
0
1
2
3
4
5
6
7
8
Tobacco Salt Alcohol Physical
inactivity
PERCENTAGE
OF
DEATHS
IN
MILLIONS
Global
9.1
7.9
6.4
4.2 3.9
3.2 3.2
0
1
2
3
4
5
6
7
8
9
10
Tobacco
Obesity
Hypertension
Physical
inactivity
Alcohol
Hyoerlipidemia
Others
PERCENTAGE
OF
DEATHS
New Zealand

6.  Unhealthy diet-
 Physical inactivity-
 Overweight and obesity-
 Smoking/ tobacco usage-
 Harmful alcohol consumption-
 Other risk factors-

7.  Income/ Wealth Status
 Education/ Qualification-
 Housing/ Residence-
 Work Status-
 Gender-
 Culture-

8. WHO, United Nation and other organisation
Initiated plan:-
 Sustainable Development Goals (SDGs)
 Multisectoral Policies and Plans (MSAPs)
 Global Monitoring Framework (GMF)
 Best- Buys plan
 Global Health Diplomacy (GHD)
Nine targets
 25% drop in premature mortality
 10% drop in harmful intake of alcohol
 30% drop in tobacco usage
 25% relative drop of hypertension and prevent
rise in obesity and diabetes
 50% people able to receive treatment and
prevent heart and stroke attacks
 80% availability of modern medicines and
technologies in government and private sectors

9.  To control tobacco and smoking
 To control unhealthy diet/ obesity and overweight/ diabetes
 To control physical inactivity/obesity and overweight/ diabetes
 To control harmful use of alcohol
 To improve health system

10.  To reduce smoking and tobacco
 To reduce unhealthy diet
 To reduce childhood overweight and obesity
 To reduce harmful use of alcohol
 To reduce physical inactivity
 To improve health system
Targets
 Reduce daily overall prevalence of smoking from
14% to 5% by 2025
 Reduce the total energy consumption of saturated
fat from 13% to 11% and salt consumption from
9g to 6g by 2025
 Reduce childhood obesity and overweight from
33% to 25% by 2025
 Reduce harmful alcohol consumption from 16%
to 14.5% by 2025
 Reduce physical inactivity from 49% to 44 and
from 33% to 30% adults and children respectively

11. Global: -
Types of CVDs :- Responsible:-
CHD 17.9 millions/ 31% of deaths worldwide in 2016
Stroke Four out of five/ 85 % of deaths mainly due to heart attack and stroke
Peripheral arterial disease One-third of deaths are premature, under the age of 70
Rheumatic heart disease 82 % deaths occurred in LMIC
Congenital heart diseases 3.8 million male 3.4 million female died due to CHD
DVT and pulmonary embolism 15 million sufferer and 116.3 DALY lost due to stroke in 2017
CHD
9 million deaths
Rest type of CVDs 3.4
millions deaths
Stroke
5.2 millions deaths

12. New Zealand : -
Responsible:-
 40% deaths yearly
 One in three deaths
 Every 90 minutes one death
 Currently, 170000 people affected with CVDs more than one in 27 people
 CHD causes 40.2% deaths in Maori and 10.5% in European
 Stroke prevalence rate is 1.6% and yearly 9000 people get affected
 Stroke affecting 2.1 of Maori and 1.8% other ethnic groups

13.  Tobacco/ Smoking-
 Unhealthy diet-
 Harmful alcohol consumption-
 Physical inactivity-
 Obesity-

14. Cardiovascular disease risk assessment (CVDRA) 2018
The PREDICT CVD
One Heart, many lives
The Indigenous Health Framework (HIF)
Diet and Physical Activity
 The Eating and Activity Guidelines for New Zealand Adults
Obesity/ Weight management
 The Clinical Guidelines for Weight Management in New Zealand Adults
Smoking
 Offer cessation support

15. New Zealand Primary Care Handbook 2012
The Heart Age Forecast
Fast Campaign 2016
Telestroke

16. Population Health Strategies:-
 Tobacco Prevention and Control Policies
 MPOWER strategies
 Dietary Policies
 Motivational population-wide strategy
Individual Strategies for the Prevention and Management of CVD:-
 Simplified CVD-Risk Screening and Management Algorithms
 Resource-Efficient Management of Acute Presentations of CVD
 Expanding Management Options by Appropriate and Affordable Combination Therapy for CVD
Health System Strategies
Task Sharing with Nonphysician Health Workers, Community Health Workers, and Treatment Supporters

18. One Heart, many lives
The Indigenous Health Framework (HIF)

19. Complications
 The most important complication is hyperglycaemia it leads to atherosclerosis which
makes the blood vessels hard and narrow. (Sone et al., 2011).
 Other risks linked to diabetes include herat failure, stroke, chronic kidney diseases,
diabetic retinopathy, Neuropathy, and amputation (Sone et al., 2011).
 Such illnesses diminish the patients’ quality of life, and possibly rapport with others
around them. (Sone et al., 2011).
Other risk factors

20. Why Diet Is an Important Intervention
 Dietary intervention helps to control glucose fluctuation and minimise possible future
health complications , with or without physical activity and medication (Kam et al., 2016).
 There is much strong evidence from globally suggested that lifestyle modification along
with a healthy diet and physical activity can prevent or delay the onset and complication
of type 2 diabetes. (The International Diabetes Federation, 2019; Green et al.,2016).
 Exercise and nutrition-based intervention for the diabetic are cost-effective (Di Onofrio et
al., 2018), which contributes to a decrease in the overall financial pressure on public care,
as well as increase patient well-being. (Kam et al., 2016)

21. Public health and Public Health Intervention
 Public health is described as "the science and art of fostering and safeguarding health and
well-being, preventing ill-health and prolonging life by coordinated social efforts"
(Ministry of Health, 2016).
 The public health sector plays a pivotal role in tracking the risk of diabetes, organising
collaborations to develop high-risk diabetes prevention services, and ensuring the quality
of those initiatives (Bergman et al, 2012).
 Considering the economic side, healthcare expenses for diabetic people are average twice
higher than people with no diabetes. (Al-Lawati, 2017). According to The American
Diabetes Association, the average expense of health care for a person with diabetes is
over $1,100 per month and $13,741 a year (Corinna, 2018).

22. Why Workplace is Important for Intervention
 The workplace has long been used as an effective environment for encouraging health and
well-being. Information regarding health and well-being can touch in a significant percentage
to the adult (working age) population (Griffiths et al., 2007).
 This is associated with the fact that many people who make up the workforce come from
groups that are traditionally difficult to reach and lower socio-economic groups, for them it is
always difficult to get information about health, wellbeing, and lifestyle (Griffiths et al., 2007)
 A second major benefit of choosing workplace is that it has a positive influence on the
economic well-being of an organisation due to productive workforce, turning into the
creation of wealth in the community as a whole (Griffiths et al., 2007; Ministry of Health, 2020)

23.  Nutrition Motivational Intervention, Di Onofrio et al. (2018) Community based long-term intervention,
implemented in Naples south Italy on type 2 diabetes people. In conclusion after the nine months of
intervention improvement seen in BMI and waist circumference, blood pressure and eating behaviour pattern.
 “Living Well, Taking Control” (LWTC) programme, Smith, et al. (2019) program was implemented in United
Kingdom (UK) Intervention was implemented in local community places on type 2 diabetic people. After six
months in the outcome, participants lost weight and improved their self-reported dietary behaviour and
health condition.
 Low Carbohydrate High Fat Diet (LCHF) intervention the study was done by Ahmed et al., (2020) in the United
States on low carbohydrate high fat diet, community-based intervention for three months in which
participations were recommended to eat low carbohydrate high fat diet (LCHF) in the assessment of post
three moths intervention, there was a significant improvement seen in A1C level, BMI, and reduction in
antihyperglycemic medication.

24.  The research article from CSIRO stated that a low carbohydrate diet and exercise program is highly effective in
reducing complication type 2 Diabetes by controlling glycaemic level and also helps in 40 percent reduction in a
medication intake (CSIRO, 2016).
 The meta-analysis done by Shrestha et al. (2018) to recapitulate the evidence on lowering blood sugar levels by
dietary interventions in working place indicated that dietary intervention in working set up lower the level of blood
glucose.
 The study done by Sluijs et al. (2010) on more than 37000 participants among which 915 incidences of diabetes
were registered over a decade, concluded that a positive association lies between higher GI food and diabetes and
fibre intake reversely associated with diabetes. Intriguingly, only starch in the carbohydrate sub-types was noted to
be related to diabetes risk. They confirmed that dietary element plays an important role in managing diabetes.
 The study was done by Asaad et al. (2016) in Alberta with the intervention of Physical Activity and Nutrition on 203
participants for 6 months, in conclusion, they found significant beneficial changes seen in A1c level, lipid profile,
BMI and dietary habits.

25.  There is robust evidence of the successful implementation of this kind of
intervention in other countries.
 Limited evidence in the literature regarding similar interventions implemented in
New Zealand.
 The dietary intervention given in the studies can be modified according to food
access, affordability and culture (Di Onofrio et al., 2018)
 The data from VDR for 2018. in 2018, 253,000 people had diabetes which is rose
from 245,000 in the year 2017 and 241,000 in 2016. It indicates poor control of
diabetes in New Zealand.
241,000
245,000
253,000
2016 2017 2018
Diabetes Growing Rate

26.  This is a long-term community-based plan primarily focused to promote well-being and
improve quality of life of Type 2 Diabetes (T2D) people which is diminished due to
complications.
 It is a renewed and comprehensive therapeutic approach that can be provided through
nutritional intervention with accurate and conscious food choices associated with active
lifestyle promotion which can be used as an effective tool to manage the disease.

27. Inclusion criteria & Exclusion criteria
Inclusion criteria.
 Type 2 diabetic patient/workers
 BMI >25.0
 Age between 24 to 64
 Diagnosed at least 1 year prior
Exclusion Criteria
 Other medical complication

28. Intervention set up & Duration of intervention
Intervention set up
 Workplaces
 Hospitals
 Large corporation
Duration of intervention
 Nine months follow up after every 3 months.

29. Intervention Procedure
 It will be divided into three phases
 5As approach (Ask, Assess, Advise, Assist, and Arrange), will assist to accept a plan that
considers personal, cultural, and lifestyle factors in advising with food selections. (Deed et al,
2016)
First phase: -
 It will include all the stakeholders Participants, Nutritionist, Program facilitator, Employer,
Trade union, Laboratory, Company fund insurance, and Ministry of Health
 Participants will be recruited as per inclusion criteria of intervention, detail information will
be given regarding intervention
 Consent will be taken, from Ministry of health,/ local government, employer and participants.

30. Second phase: -
 Stakeholders involved, Participants, Nutritionists, Program facilitator, Laboratories,
Company fund insurance, and Ministry of Health.
Pre-intervention assessment of outcome measure will be done
 Physical assessment - BMI, Waist circumference, Eyes: visual acuity Feet; sensation, skin
condition, pressure areas and blood pressure (RACGP, 2014).
 Laboratory testing: to measure baseline metabolic parameters, fasting plasma glucose
(FPG), lipids, and A1C (Smith, et al.,2019).
 Dietary Self-Care Behaviour (DSCB) Questionnaire
 Well-d app- based on “Diet Evaluation System (DES)”

31.  SNAP (Smoking, nutrition, alcohol, physical activity) guideline will be given (RACGP, 2014).
 Recommended diet –low carbohydrate high-fat diet (LCHF).Carbohydrate intake to
≤20 g/day or 5%–10%, protein 20%–25% and fat intake 65%–70% of total calorie intake
(Ahmed et al., 2020).
 Instruction-- participants will be recommended to eat only when they feel hungry, advised
not to eat late at night, asked to drink a minimum of six to eight glasses of water in a day,
at list six to eight hours of sleep and 30 minutes of physical activity in a day. (Ahmed et al.,
2020).

32. Third phase: -
 Stakeholders’ Participants, Nutritionist, Program facilitator, Employer, Trade union,
Laboratory, Company fund insurance, and Ministry of Health
 Follow up meeting will be held after every three months
 Same instruction and advice will be given
 Outcome measures will be checked and reviewed after every three months of
Intervention
 Personal feedback will be taken every three months

33. Fourth phase: -
 Stakeholders’ Participants, Nutritionist, Program facilitator, Employer, Trade union, and
Ministry of Health
 Analysis of all the outcome measure which will be taken every post three months of
intervention.
 The cost will be checked for entire months of intervention
 Personal feedback will be taken from all the participants
 Reported will be submitted to Employer, Trade union and Ministry of Health

34.  Employee/ Participants
 Nutritionist
 Program facilitators
 Employer/ administrative management
 Trade unions
 Company insurance funds
 Ministry of Health

35. The Role of Ministry of Health
 Permission for the implementation of the intervention, financial support, and ensuring the
safety of intervention places,
 Creating a supportive environment by providing healthcare workers, providing free
laboratory testing, motivating an employee to participate by creating awareness about
diabetes through a national and local media campaign.
 Developing public health policies (Laxminarayan, 2011) that includes food and agricultural
policies that will increase healthy food availability, banning, or heavy taxing on unhealthy
foods.

36.  Participants dropouts during the nine months of intervention (Crichton et al., 2015)
 Participants may be seasonal workers or migrant,
 Language barrier
 Participants may have a financial issue due to Nutritious food tends to cost more as the
intervention is long-term
 Non-availability of food in the working place as well as locality
 Personal, family, cultural issues (Fitzgerald et al., 2015), other medical complication, the
position at the work and working time shifts
 Financial issue to carried out intervention due to fewer allocation funds from the Ministry of
Health.

37.  Community initiatives for delivering affordable fresh fruit and vegetables .(Ex. Nourished for Nil)
 Government schemes, incentives, and the organizational structure that supports staff and their
culture, to solve funding issue (Quirk et al.,2018)
 The government initiatives by starting stalls and shops of vegetables and fruits selling at
affordable prices for lower-income people. (Sacks et al., 2015
 Food labelling for those who have language barriers (Kerins et al.,2018)
 To prevent dropout, holding daily communication with participants during the intervention
period (Crichton et al., 2015).
 By developing guidelines to facilitate the implementation of health intervention at workplace.
(Martinsson et al., 2016).

38. hort term: -
 Assessment of all the outcome measures every three months
 Dietary Self-Care Behaviour (DSCB) Questionnaire
 Monitoring participant through dietary self-monitoring mobile app named
Well-D; (Ahn et al.,2019)
 Feedback questioner after every three months (Crichton et al., 2012)

39. Long term: -
 Assessment of all the outcome measures after 9 months (long term effect)
 Analysing all the outcome measures
 Costing
 Final participant feedback

40.  As per previous, this kind of interventional study has shown significant improvement in the
quality of life of Type 2 Diabetic people, so it can be implemented in NZ set up.
 As per economic analysis diet and exercise-based intervention for the diabetic is always cost-
effective especially in highly complicated cases (Di Onofrio et al., 2018).
 Participants and will not require big amounts of personnel or financial resources.
 It is a community-based intervention at the workplace it will help to cover a larger population
of groups.
 It will also help to improve economic and social well-being of workers, increase the
productivity of the employer/ company, and reduce extra-pressure on healthcare services and
overall economic burden of the country.

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